No benefit seen with 5ASA combined with corticosteroids for acute, severe UC
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Corticosteroids plus 5-aminosalicylic acid did not benefit patients with acute, severe ulcerative colitis compared with corticosteroids alone, according to a presenter at the Crohn’s and Colitis Congress.
“These results should inform our [inflammatory bowel disease] community, and specialists when they manage these challenging patients, to stop unnecessary 5ASA during hospitalization,” Shomron Ben-Horin, MD, professor of medicine at Sheba Medical Center in Tel Aviv, Israel, said during the presentation. “On the other hand, I think future studies are warranted to investigate this interesting exploratory signal of a better long-term outcome, at least as far as a reduced need for biologics by day 90 among the patient receiving the combination of corticosteroids with 5ASA.”
Ben-Horin and colleagues screened 346 patients with acute, severe UC from 10 centers in six countries. They included 149 patients, who wererandomly assigned to receive either corticosteroids alone (n=73) or corticosteroids plus 5ASA (n=76). The percentage of patients who responded to treatment by day 7 served as the primary outcome, defined by a 3-point drop in the Lichtiger score and an absolute score less than 10 without a need for rescue medications or colectomy.
According to study results, 53 patients who received corticosteroids plus 5ASA responded by day 7, compared with 58 patients who received corticosteroids alone. Ben-Horin and colleagues observed no difference between groups in hospitalization duration or C-reactive protein normalization rate. In addition, the colectomy rate by day 90 was similar between the treatment groups; however, the need for biologics was numerically lower by day 30 and day 90 among patients who received corticosteroids plus 5ASA.
“The response to treatment was not different between the two groups, and there was no superiority in giving corticosteroids with 5ASA for the primary outcome,” Ben-Horin said. “Neither was it superior to give corticosteroids with 5ASA for secondary outcomes of a need for salvage therapy.”
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Ben-Horin S, et al. Corticosteroids and 5ASA vs. corticosteroids alone for acute severe ulcerative colitis: A randomized controlled trial. Presented at: Crohn’s and Colitis Congress; Jan. 20-22, 2022 (virtual meeting).
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